Medicare Addresses Mail Order Waste, Refill Synchronization for 2014

Two Medicare Part D policy changes NCPA has long advocated for to reduce medication waste and promote meaningful adherence will take effect in the 2014 plan year.

The new edition of the Medicare & You handbook mailed to all Medicare beneficiaries last month addresses both automatic mail order refills and prorated copays to facilitate medication refill synchronization efforts, such as NCPA’s Simplify My Meds™ program.

First, in response to complaints from patients (and NCPA staff and members), Medicare is requiring drug plans to confirm patients want a prescription refill mailed to them prior to shipping it.

Here’s how Medicare describes this change in the handbook:

“Do you get automatic refills of your prescriptions by mail?

“Some people with Medicare get their prescription drugs by using an ‘automatic refill’ service that automatically delivers prescription drugs when you’re about to run out. However, in the past, some prescription drug plans weren’t checking to see if customers still wanted or needed a prescription drug. Since pharmacies can’t restock the prescription drug if it’s sent through the mail and generally won’t cancel the order, you can’t return unwanted refills or get a refund. This means some automatic delivery services were creating waste and unnecessary costs for people with Medicare and the Part D program.

“By January 2014, to make sure you still need a prescription before they send you a refill, prescription drug plans should get your approval to deliver a prescription, new or refill, before each delivery, except when you ask for the refill or request a new prescription. This may be a change for you if you’ve always used mail-order and haven’t had the opportunity to confirm your need for refills. Be sure to give your drug plan the best way to reach you so you don’t miss the refill confirmation call or other communication. The plan won’t automatically ship your refills unless you confirm you still want to get the order. This new policy won’t affect refill reminder programs where you go in person to pick-up the prescription and it won’t apply to long-term care pharmacies that give out and deliver prescription drugs.”

Second, CMS has taken a meaningful step forward in its commitment to improving medication adherence by making it easier for patients to have their prescription medications “synchronized,” or refilled all at the same time. By coordinating all of a patient’s medications to be refilled on the same day each month, pharmacists are able to prevent gaps in therapy and look for cost-saving alternatives, both of which can improve adherence, as studies have shown.

One impediment to the growth of synchronized refill programs has been difficulty getting payer coverage for special refill quantities that are needed to align multiple prescriptions to one refill date. In order to coordinate a patient’s medications to come due on a single day of the month, ‘short filling’ of some of the medications may be necessary. In some cases, patients would face a full month’s copay for a few days’ supply of their medication. In most cases, the medication would be flagged as being refilled too soon and therefore not covered by insurance, leaving the patient to pay out of pocket to cover the cost of these short fills.

To ease this burden, here is what Medicare has to say in the handbook about this:

“Usually, the amount you pay for a covered prescription is for a one-month supply of a drug. However, starting in 2014, you can request less than a one-month supply for most types of drugs. You might do this if you’re trying a new medication that’s known to have significant side effects or you want to synchronize the refills for all your medications. If you do this, the amount you pay is reduced based on the quantity you actually get. Talk with your prescriber to get a prescription for less than a one-month supply.”

The concept of a prorated co-pay for a less than 30-day supply should reduce waste and aid adherence by making it easier to enroll Part D patients in Simplify My Meds or other synchronization programs.

NCPA has pushed for these pro-patient, pro-pharmacy, pro-taxpayer positions for several years, most notably in comments related to the Centers for Medicare & Medicaid Services’ (CMS) annual “Call Letters.”